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Vulvar Dermatitis

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81. Basal Cell Carcinoma (Treatment)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

82. Basal Cell Carcinoma, Eyelid (Treatment)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

83. Fixed Drug Eruptions (Treatment)

eruption. J Am Acad Dermatol . 2003 Dec. 49(6):1003-7. . Ozkaya-Bayazit E, Bayazit H, Ozarmagan G. Drug related clinical pattern in fixed drug eruption. Eur J Dermatol . 2000 Jun. 10(4):288-91. . Fischer G. Vulvar fixed drug eruption. A report of 13 cases. J Reprod Med . 2007 Feb. 52(2):81-6. . Gupta S, Gupta S, Mittal A, David S. Oral fixed drug eruption caused by gabapentin. J Eur Acad Dermatol Venereol . 2009 Feb 19. . Katoulis AC, Bozi E, Kanelleas A, et al. Psoriasiform fixed drug eruption caused (...) Allergy Clin Immunol . 2003 Sep. 112(3):609-15. . Mizukawa Y, Shiohara T. Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep . 2009 Jan. 9(1):71-7. . Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol . 2009 Aug. 9(4):316-21. . Weedon D. The lichenoid reaction pattern ('interface dermatitis'). Skin Pathology . 2nd ed. London, England: Churchill Livingstone; 2002. 42-43. Smoller BR, Luster AD, Krane JF

2014 eMedicine.com

84. Basal Cell Carcinoma (Treatment)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

85. Balanitis Circumscripta Plasmacellularis (Treatment)

plasmacellularis (plasma cell balanitis) and are not curative. Intralesional interferon-alfa was found to be helpful in treatment of the vulvar analog of balanitis circumscripta plasmacellularis (plasma cell balanitis). [ ] Griseofulvin therapy and oral tetracycline have been tried without success. Next: Surgical Care The treatment of choice for balanitis circumscripta plasmacellularis (plasma cell balanitis) is circumcision, which is usually curative. [ , , ] Patients must be informed that circumcision (...) SR, Patterson JW, Cousar JB, Wick MR. Idiopathic lymphoplasmacellular mucositis-dermatitis. J Cutan Pathol . 2010 Apr. 37(4):426-31. . Hernandez-Machin B, Hernando LB, Marrero OB, Hernandez B. Plasma cell balanitis of Zoon treated successfully with topical tacrolimus. Clin Exp Dermatol . 2005 Sep. 30(5):588-9. . Roe E, Dalmau J, Peramiquel L, Perez M, Lopez-Lozano HE, Alomar A. Plasma cell balanitis of zoon treated with topical tacrolimus 0.1%: report of three cases. J Eur Acad Dermatol Venereol

2014 eMedicine.com

86. Nonneoplastic Epithelial Disorders of the Vulva (Treatment)

the following: Lichen sclerosus Squamous cell hyperplasia (with and without atypia) (localized neurodermatitis) Primary irritant dermatitis Fixed drug eruption Reiter disease Lupus erythematosus Darier disease Aphthosis and Behçet disease Pyoderma gangrenosum Plasma cell vulvitis Vulvar vestibulitis Blistering diseases involving the vulvar region include the following: Familial benign chronic pemphigus (Hailey-Hailey disease) Pigmentary changes involving the vulvar region include the following (...) -scratch-itch cycle. The initial stimulus to itch may be underlying seborrheic dermatitis, intertrigo, tinea, or psoriasis; however, in most cases, the underlying cause is not evident and may have been transient vulvitis or vaginal discharge. [ ] Any itching disease of the vulva may become secondarily lichenified. Primary irritant dermatitis In the absence of any immune reactivity, this condition is a common cause of vulvar burning and pruritus due to irritation. Chemical agents that remove surface

2014 eMedicine.com

87. Paraneoplastic Diseases (Treatment)

given together with ultraviolet-A (UV-A) phototherapy. Extramammary Paget disease Paget disease is characterized by a solitary, pruritic (but painless), sharply demarcated, erythematous, superficial, eczematous, slightly infiltrated plaque, which usually appears on the areola. The lesion of (EMPD) is clinically indistinguishable from that of Paget disease, except for its location; lesions in persons with EMPD typically appear on the apocrine gland–bearing perianal or vulvar skin. Occasionally, cases (...) diagnosis of EMPD includes Bowen disease, amelanotic superficial spreading malignant melanoma, and eczematous dermatitis. Clinical course and prognosis Skin lesions slowly increase in size. Over time, the lesions may progress from pruritic to painful, and they may become ulcerated. Regional lymph nodes may become involved. The general course of the disease depends on the presence of an underlying internal cancer. EMPD patients have a 5-year survival rate of 72-85%. Patients with EMPD without an internal

2014 eMedicine.com

88. Vulvovaginitis (Treatment)

: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms (...) , and a feeling of rawness that is aggravated by stress, exercise, tight clothing, coitus, and tampon use. The pain is usually not considered constant but is elicited by any attempt to enter the vagina. Other symptoms may include the following: Irritating vaginal discharge Vulvar burning sensation Small spots of erythema around the vestibular glands, with rare ulceration Contact dermatitis Pruritus is the cardinal symptom. However, an acute reaction may develop as a result of exposure to a potent irritant

2014 eMedicine.com

89. Paraneoplastic Diseases (Overview)

given together with ultraviolet-A (UV-A) phototherapy. Extramammary Paget disease Paget disease is characterized by a solitary, pruritic (but painless), sharply demarcated, erythematous, superficial, eczematous, slightly infiltrated plaque, which usually appears on the areola. The lesion of (EMPD) is clinically indistinguishable from that of Paget disease, except for its location; lesions in persons with EMPD typically appear on the apocrine gland–bearing perianal or vulvar skin. Occasionally, cases (...) diagnosis of EMPD includes Bowen disease, amelanotic superficial spreading malignant melanoma, and eczematous dermatitis. Clinical course and prognosis Skin lesions slowly increase in size. Over time, the lesions may progress from pruritic to painful, and they may become ulcerated. Regional lymph nodes may become involved. The general course of the disease depends on the presence of an underlying internal cancer. EMPD patients have a 5-year survival rate of 72-85%. Patients with EMPD without an internal

2014 eMedicine.com

90. Paget Disease, Extramammary (Overview)

antigen is negative. No epithelial mucin is seen in these tumor cells. Crocker described a patient with erythematous patches on his penis and scrotum. Since he made this distinction, the term EMPD is more commonly used to describe the condition in women. This process targets the genital skin, perianal skin, and other cutaneous sites rich in apocrine glands. EMPD is not a common disorder, but it must be considered in the differential diagnosis of patients with chronic genital or perianal dermatitis (...) as pancytopenia and back pain. Curr Oncol . 2009 Sep. 16(5):81-3. . . Sendagorta E, Herranz P, Feito M, et al. Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod - proposal of a therapeutic schedule. J Eur Acad Dermatol Venereol . 2009 Oct 15. . Marchitelli C, Peremateu MS, Sluga MC, et al. Treatment of primary vulvar paget disease with 5% imiquimod cream. J Low Genit Tract Dis . 2014 Oct. 18(4):347-50. . Liau MM, Yang SS, Tan KB, Aw CW. Topical imiquimod

2014 eMedicine.com

91. Gynecologic Pain (Overview)

. [ ] Diagnosis of the erythematous and often painful skin lesions can be elusive because they may closely resemble other inflammatory and infectious causes of vulvar pain. An exhaustive search for the offending substance is sometimes needed, and that may be best handled by an allergist. Urinary incontinence, sometimes unreported, can also be responsible for contact dermatitis. A detailed history along with a 1-2 day phenazopyridine (Pyridium) test can be employed, looking for orange staining of a sanitary (...) pad. Correction of incontinence, along with warm rinsing and a skin protectant are management strategies. Diaper dermatitis can develop in a remarkably short time when skin is exposed to fecal material. Discussion can be awkward but should not be deferred. Allergic dermatitis (e.g. latex) may also occur with attendant itching and pain. Again, an allergist is an important team member. Behavioral and Psychological Behavioral and psychological causes of vulvar pain require careful, appropriate

2014 eMedicine.com

92. Fournier Gangrene (Overview)

with cocaine [ ] Urethral instrumentation Prosthetic penile implants Intramuscular injections Steroid enemas (used for the treatment of radiation proctitis) Rectal foreign body [ ] In women, septic abortions, vulvar or Bartholin gland abscesses, hysterectomy, and episiotomy are documented sources. In men, anal intercourse may increase risk of perineal infection, either from blunt trauma to the area or by spread of rectally carried microbes. In children, the following have led to the disease: Circumcision (...) inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD. Photograph of a morbidly obese male with long-standing phimosis. This condition led to urinary incontinence, perineal diaper rash–like dermatitis, and urinary tract infection. Ultimately, he presented with exquisite perineal pain. An examination with the patient under anesthesia was necessary to discover the necrotizing infection that appeared

2014 eMedicine.com

93. Fixed Drug Eruptions (Overview)

pustulosis, lichenoid dermatitis, vasculitis, Stevens-Johnson syndrome, or fixed drug eruption (FDE). The term fixed drug eruption describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with reexposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in addition to "lighting up" the older hyperpigmented lesions (...) -Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol . 2003 Dec. 49(6):1003-7. . Ozkaya-Bayazit E, Bayazit H, Ozarmagan G. Drug related clinical pattern in fixed drug eruption. Eur J Dermatol . 2000 Jun. 10(4):288-91. . Fischer G. Vulvar fixed drug eruption. A report of 13 cases. J Reprod Med . 2007 Feb. 52(2):81-6. . Gupta S, Gupta S, Mittal A, David S. Oral fixed drug eruption caused by gabapentin. J Eur Acad Dermatol Venereol . 2009 Feb 19. . Katoulis AC, Bozi E

2014 eMedicine.com

94. Syringoma (Overview)

cells. Some investigators have suggested that cases of eruptive syringoma may represent a hyperplastic response of the eccrine duct to an inflammatory reaction rather than a true adnexal neoplasm. [ ] In this setting, the term syringomatous dermatitis may be more appropriate. Likewise, the scalp “syringomas" seen in represent a reactive proliferation in response to the fibrosis. Previous Next: Etiology Syringomas are usually sporadic, but more than 10 cases of familial syringomas have been reported (...) dermis. J Am Acad Dermatol . 2014 Nov. 71 (5):e206-7. . Eckert F, Nilles M, Schmid U, Altmannsberger M. Distribution of cytokeratin polypeptides in syringomas. An immunohistochemical study on paraffin-embedded material. Am J Dermatopathol . 1992 Apr. 14(2):115-21. . Jamalipour M, Heidarpour M, Rajabi P. Generalized eruptive syringomas. Indian J Dermatol . 2009. 54(1):65-7. . . Karatzi C, Stefanidou M, Chaniotis V, Evangelou G, Krueger-Krasagakis S, Krasagakis K. Treatment of giant vulvar syringomas

2014 eMedicine.com

95. Basal Cell Carcinoma, Eyelid (Overview)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

96. Basal Cell Carcinoma (Overview)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

97. Basal Cell Carcinoma (Overview)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

98. Vaccinia (Overview)

. The sequelae of eczema vaccinatum include prolonged hospital stays and, occasionally, death. Recent research has shown that patients with atopic dermatitis have an overabundance of a class A scavenger receptor known as macrophage receptor with collagenous structure (MARCO) on keratinocytes. Vaccinia virus bound directly to MARCO increases susceptibility to eczema vaccinatum. This breakthrough represents a potential area for future therapeutic strategies to prevent vaccinia virus infection in patients (...) to 21 days following vaccination. Vaccinia virus should not be administered to children younger than 3 years, individuals with eczema or CNS disorders, or immunosuppressed individuals. Individuals vaccinated within the preceding 21 days can also spread the virus to unvaccinated contacts. In particular, these individuals should avoid contact with young children, immunocompromised persons, pregnant persons, and individuals with a history of atopic dermatitis. If this contact is unavoidable, vaccinated

2014 eMedicine.com

99. Incontinence, Urinary: Nonsurgical Therapies (Overview)

capabilities of the bladder or urethra. Urogenital fistulas are a classic example. A nonfunctioning urethra can result in continuous leakage. Scarring and fibrosis from previous surgery, partial urethral resection for vulvar cancer, and urethral sphincter paralysis due to lower motor neuron disease can cause the urethra to fail. Pelvic irradiation may not only cause urogenital fistula but in rare cases causes bladder noncompliance that results in continuous incontinence. Congenital malformations

2014 eMedicine.com

100. Hidradenitis Suppurativa (Overview)

of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol . 2008 Dec. 159(6):1309-14. . Hynes PJ, Earley MJ, Lawlor D. Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa. Br J Plast Surg . 2002 Sep. 55(6):507-9. . Rhode JM, Burke WM, Cederna PS, Haefner HK. Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med . 2008 Jun. 53(6):420-8. . Frohlich D, Baaske D, Glatzel M

2014 eMedicine.com

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